So let's jump into it. My first talk is, as you can see, sideline decision-making. These are my disclosures, none of which have to do with anything relative to this talk. I'm going to, or I'd like to share with you my personal perspective regarding how important it is to develop healthy relationships between players, trainers, and coaches, and how that helps you succeed in your role as a team physician. And I'll sort of be, I think, setting the table for the subsequent three speakers by giving this introductory talk. Team physician, I tell the residents, is probably the most unique role of any physician in all of medicine. And because of that uniqueness, it makes that job both challenging and exciting at the same time. And it could actually even be fun. It's a portion of your residency program, of any residency program, that really doesn't deserve the focus that it probably gets, and makes it even more important for orthopedic residents that are not planning to do a fellowship in sports to really pay attention to their mentor in that program that serves in the role as a team physician. I think there's a difference between a team physician and a team surgeon. Probably the easiest way to talk about it is to say that when a player gets hurt, tears their ACL or tears their meniscus or dislocates a shoulder for the third time, and a trainer tells the athlete that they need surgery, if you're a team physician, the player knows already about who you are and your skills. If you're a team surgeon, maybe not so much. However, I do think there is a need for both team physicians and team surgeons. Let's talk about relationships, which is basically the substance of my discussion. First of all, relationships with players. In my opinion, nothing is more important than developing a sense of trust between yourself and players. A Army Chief of Staff once said not too long ago, trust. With it, you can do almost anything. Without it, you can do almost nothing. How do you develop or build trust with a team? My first pearl is you have to spend time with the players, basically when you don't have to spend time with the players. What does that mean? It means hanging out at practice, training rooms, traveling with the players when it's appropriate, just hanging out with them, talking about what's going on, maybe in terms of their role on the team or the team's performance in general. There are no RVUs associated with this type of commitment, but it's critically important to develop in developing a relationship with the athletes. Basically, you want to get them to understand that even though you may be the team physician, when he or she gets hurt or injured, you are their personal physician. Relationship with athletic trainers. The athletic trainer is the most critical member of the sports medicine team and is basically what I call your storefront window to how the athlete views his or her quality of care. The athletic trainer's skills directly reflect on you as head of that sports medicine health care team. So, pearl number two regarding athletic trainers. Because they're so important in the role that they play, whenever possible, you as a team physician should try and have a significant input into who that athletic trainer is. Input from administration and coaches are certainly very important, but the team physician should have significant say into the selection, the evaluation, and the retention of their athletic trainers. Relationship with coaches. It's common sense it's easier to establish a good relation with a coach the longer you as a team physician have remained in that role. Irrespective of that, whether it's a new coach or you're in a new role, the coach or more importantly, the administration's need to understand that your job, simply stated, is both the short and long-term good health of the athlete and not necessarily winning games. Here's a helpful hint, actually, that Dr. Amendola taught us. It'd be helpful if you have scheduled regular meetings with both the coaches and or the trainers to discuss an athlete's availability, given any pending game situation. What does this do? This helps prevent miscommunication issues that invariably arise and helps build trust within that sports health group. Some additional hints regarding relationships with coaches. Never lie to a coach about the severity of an injury, which is sometimes difficult to avoid, particularly if he's a alpha-type individual and you're just stepping into that role. Number two, make sure that what you tell the athlete regarding the risks versus the benefits of managing that particular injury is exactly what the coach hears as well, and ideally, the coach and the athlete should hear it at the same time, and that helps prevent some miscommunication. Resist the pressure to make too hurried a diagnosis. It's better to make a correct diagnosis than the fastest one. Some additional pearls, and this should be actually addressed at the beginning of the season. Who, or address this question, who answers to who around here? In other words, you need to establish a clear chain of command prior to any given season, preferably in writing, with the head team physician as the head of that chain. You should also support second opinions when requested, and not only support them but help and assist in making them. But remember, ultimately, whether or not an athlete returns to play or practice is your decision, and your decision alone as the head team physician. We have to accept the reality of the situation, and I call those decision-modifying situations. For example, what is the risk tolerance that everyone is willing to accept regarding any particular injury or illness? What's the timing of the injury in any given season? Is this an injury that occurs the first day of spring practice or two days before a national championship game? Those are decision-modifying situations. Realistically, you have to appreciate there's going to be pressure from the athlete, and the athlete's desire to compete frequently results in masking the severity of the injury. There's going to be external pressure from the coaches, from the family, from the agents. There's also, and we'll talk about this briefly, fear of litigation. If you restrict somebody unnecessarily and keep them out of competition, or probably more ominously, if you return them to competition too soon. And then finally, a real situation everybody faces, particularly if you take care of high-profile athletes, are conflicts of interest, because they deal directly with the financial benefits that you as a team physician may have access to. Decision-making itself. You're always asked, how can I go back in? Often, the athlete will heavily rely on your recommendation regarding that above decision. What makes this role as a team physician much more of an art than maybe taking care of patients that are not athletes is how you manage this situation, particularly in game-day situations. What does that all mean? On the one hand, with few exceptions, you should never dictate or pontificate your answer. You should never impose your will on any given situation. Remember, this is probably more than any other way in clinical practice. This is a shared decision-making process. There is a huge need to explain risks and benefits in terms that the athlete clearly understands. And this, at least in my experience, requires more than one quick decision made on a sideline of a heated football contest. But on the other hand, you can't avoid, you have to avoid being too ambivalent. In presenting these different options to the athletes, you try and avoid presenting them as, oh, these are all great options. You basically can try and guide the athlete into making what you think the best decision is. And a little trick that I found useful is to tell the athlete that if you, if the athlete was, you were my son or daughter, this is what I would recommend. But remember, at the end of this decision-making process, it's a shared decision process. And a decision needs to be made. The decision needs to be decisive, right or wrong. Make a decision. Even if that decision is, you know what, I don't know what the best answer is, but I'll find out. As the saying goes, the road is paved with flat squirrels who couldn't make a decision. Game day decisions are not easy. They're extremely difficult because of those variables that I mentioned earlier. As far as liability is concerned, it's even more important today than ever before to document everything you tell an athlete, whether it's in a formal training room setting or whether it is at a pregame meal or on a plane traveling to or from a game. Because the reality of it in today's indigenous world, medical liability is becoming more and more of a concern when you're taking care of professional athletes, and even now it's trickling down to college athletes with NIL contracts. You never heard before discussions about personal group asset protections when you served as a team physician, but now that topic is creeping into the discussion. Here are some final pearls. Always remain open-minded and receptive to new surgical techniques. You don't have to be the first one to do the technique, but it's unacceptable to be the last. Number two, frequently ask for feedback from your sports healthcare team and how to improve things such as communication at the end of the season. If you share team coverage like many of us do, responsibilities with other physicians, it's very helpful that both of you have the same philosophy on how to treat any given injury or illness. And finally, try and hold an annual celebration for the sports healthcare team at the end of the season and thank them for their efforts in taking care of these very unique group of patients. So in conclusion, being a team physician is probably the most unique specialty in all of orthopedics. This role has evolved over the past 50 years and hopefully it will continue to evolve. As someone said, we didn't come all this way just to come all this way. So thank you very much for your attention and we'll have the next speaker. Thank you.

sideline decision-making

team physician

healthy relationships

trust with players

continuous learning